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Final Rule Implementing MACRA

On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule (the “Final Rule”) implementing the Medicare Access and Children’s Health Insurance Program (CHIP) Authorization Act of 2015...more

Eighth Circuit Holds that a Reasonable Interpretation of an Ambiguous Law Does Not Give Rise to FCA Liability

On August 8, 2016, the Eighth Circuit, in Olson v. Fairview Health Services of Minnesota, affirmed the dismissal of a False Claims Act (“FCA”) suit alleging that the University of Minnesota Medical Center (“UMMC”)...more

Eighth Circuit Affirms that an Objectively Reasonable Interpretation of an Ambiguous Regulation Defeats Liability Under the False...

In United States ex rel. Donegan v. Anesthesia Associates of Kansas City, P.C., 833 F.3d 874 (8th Cir. 2016), the Eighth Circuit affirmed that a defendant cannot be liable under the False Claims Act (“FCA”) for claims for...more

HHS-OIG increases beneficiary inducement CMP nominal gift amounts from $10 to $15 per gift and $50 to $75 per year

The beneficiary inducement civil monetary penalty law generally prohibits health care providers from providing gifts to a Medicare or Medicaid beneficiary—including any free or discounted item or service—if the provider...more

Eighth Circuit Affirms that Retaliation Under False Claims Act Requires Showing that Retaliation Was Motivated Solely by...

On May 20, 2016, the Eighth Circuit affirmed the District Court’s grant of summary judgment to defendant on Plaintiff’s False Claims Act (“FCA”) retaliation claim against his former employer. In Elkharwily v. Mayo Holding...more

False Claims Act: Recent First Circuit Opinion on Remand in U.S. ex rel. Escobar v. United Health Services

Earlier this year, the U.S. Supreme Court’s important opinion in Universal Health Services, Inc. v. U.S. ex rel. Escobar, 136 S. Ct. 1989 (2016), dealt with the issue of whether a so-called “implied certification” that a...more

HHS Releases Inflation Adjusted Federal Civil Penalties

The Department of Health and Human Services has issued new interim final rules to adjust a variety of Federal Civil Penalties for inflation. The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015...more

The First Circuit Rules On Materiality And Rule 9(b) In Two FCA Opinions

On November 22, 2016, the United States Court of Appeals for the First Circuit issued two False Claims Act (FCA) opinions in the continuing debate over the parameters of the FCA. In United States ex. rel. Escobar et al. v....more

On Remand, First Circuit Finds Violations in Escobar Were Material

In June, the Supreme Court issued Universal Health Services, Inc. v. U.S. ex rel. Escobar, a landmark opinion in which the Supreme Court addressed the standard for pleading materiality in FCA implied certification cases. The...more

CMS Issues Final Rule on Off-Campus Hospital Department Reimbursement

As of January 1, 2017, hospitals will receive lower Medicare reimbursement for items and services provided at certain off-campus provider-based facilities. This Alert provides an overview of the new reimbursement framework...more

The Federal Government Holds Individuals Responsible for Involvement in Corporate Healthcare Fraud and Abuse

In September 2016, three corporate officers in two healthcare fraud and abuse cases settled allegations that they were personally liable for violations of federal fraud and abuse laws. These settlements come one year after...more

[Webinar] The “Risky Business” of the Federal False Claims Act: Strategic Thinking for 2017 - December 8th, 12:00pm ET

Calling in-house counsel and top executives at government and defense contractors, health care and long term care providers, and manufacturing companies. On December 8 at 11:30 am ET, join Williams Mullen attorneys at this...more

Labor & Employment Law Under President-Elect Trump

In the wake of the election results, the question on everyone’s mind now is: What impact will President-Elect Trump have on employers? Trump has thus far given few details on his thoughts on labor and employment. But with...more

When Can Violation of a Condition of Participation Result in False Claims Act Liability? Update on Escobar’s Materiality Standard

In June, I published a blog article on a decision of the United States Supreme Court that appeared to change the law applicable to “false certification” in the 7th Judicial Circuit Circuit. The Supreme Court decision in...more

False Claims Act Basics – Known Overpayment Becomes False Claim

The Federal False Claims Act (“FCA”) provides a very strong enforcement tool to the federal government. The FCA also provides the opportunity for whistleblowers to bring “qui tam” cases and collect a portion of the recovery...more

D.C. District Court Bucks the Trend and Rules for Hospital in Provider Tax Case

Many states assess taxes against hospitals and other providers as a means of funding their Medicaid and other healthcare-related programs. The revenue generated by the taxes is used, with CMS’s approval, to fund Medicaid...more

When Does An Overpayment Become Fraud? How Simple Inattention Can Expose You to Penalties for Fraudulent Activities

If you are involved in any way in the health care system, it should be obvious by now that the government has committed ever increasing resources to the prosecution of fraud and abuse cases. Simply put, from a governmental...more

Stark Law Updates in 2017 Medicare Physician Fee Schedule Final Rule

On November 2, the Centers for Medicare & Medicaid Services (CMS) finalized the 2017 Medicare Physician Fee Schedule (PFS) rule. This rule, which takes effect on January 1, 2017, updates payment policies and rates for...more

What Impact Could Trump's Election Have on Employers?

The election is over. The vote is in. Donald Trump will be our 45th President. And, for the first time since 2006 (when the 109th Congress was in session during the Bush administration), come 2017, a Republican President will...more

2016 End of Year Plan Sponsor “To Do” List: Health & Welfare

As 2016 comes to an end, we are pleased to present you with our traditional End of Year Plan Sponsor “To Do” Lists. Like last year, we are presenting our “To Do” Lists in three separate Employee Benefits Updates. Part 1 of...more

Health Care Group News: Section 1557's Nondiscrimination Mandates

Physicians and other health care providers receiving federal funding, including Medicaid but excluding Medicare Part B, are subject to new regulatory requirements implementing Section 1557 of the Affordable Care Act...more

North District of California Misconstrues Express False Certification Liability

This summer, the Northern District of California issued an opinion in an intervened case that expanded the theory of express false certification to a startling degree. Ruling on a motion to dismiss, the court in U.S. ex rel....more

Making Sense of the MACRA Final Rule – Part 3 of 3: Merit Based Payment Incentive System (MIPS)

The Centers for Medicare & Medicaid Services (CMS) recently released its final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Among its numerous changes,...more

Provider Self-Disclosure Decisions – Voluntary Disclosure Process

The decision whether or not to voluntarily disclose non-compliance to the government can be very difficult. Not every case is clear. Clearly not every situation where there has been a billing error amounts to fraud or...more

CMS Final Rule Prohibiting Nursing Home Use of Arbitration Agreements Put On Hold

This morning, U.S. District Court Judge Michael P. Mills granted a preliminary injunction in the U.S. District Court for the Northern District of Mississippi, putting on hold the looming November 28, 2016 deadline that would...more

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